title: Comparison of abluminal biodegradable polymer biolimus-eluting stents and durable polymer everolimus-eluting stents in the treatment of coronary bifurcations.
abstract: OBJECTIVE
  To compare biodegradable polymer biolimus-eluting (BES) with abluminal drug elution and durable polymer everolimus-eluting (EES) stents in the treatment of bifurcation lesions.
  
  
  BACKGROUND
  The persistence of a polymer in drug-eluting stents (DES) following drug elution has been viewed as a possible culprit for restenosis. DES with biodegradable polymer may thus be associated with improved clinical outcomes, especially in high-risk lesions such as those at bifurcation sites.
  
  
  METHODS
  We performed a retrospective study of consecutive de novo bifurcation lesions treated with EES between October 2006 and October 2011 and BES between February 2008 and March 2012. Study endpoints included major adverse cardiac events (MACE) defined as all-cause death, myocardial infarction (MI), including peri-procedural MI, and target vessel revascularization (TVR) as well as target lesion revascularization (TLR) separately.
  
  
  RESULTS
  We analyzed 236 bifurcation lesions treated with either BES (79 lesions in 69 patients) or EES (157 lesions in 154 patients). Patient and procedural characteristics were broadly similar between the two groups. Estimated MACE and TVR rates at 2-year follow-up were similar between the BES and EES groups (MACE = 13.6 ± 4.6% vs. 14.6 ± 3.2% (P = 0.871); TVR = 6.9 ± 3.5% vs. 8.0 ± 2.7% (P = 0.889). No significant differences were noted between the two groups following propensity-score matched analysis. There was no probable or definite stent thrombosis.
  
  
  CONCLUSIONS
  BES use in the treatment of bifurcation lesions appears to be associated with good clinical outcomes, comparable to those seen with EES, at long-term follow-up. These results are hypothesis-generating and need to be validated with larger studies.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Imperial College London, London, United Kingdom.
authors.forename: Charis
authors.initials: C
authors.lastname: Costopoulos
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Toru
authors.initials: T
authors.lastname: Naganuma
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sticchi
authors.forename: Santo
authors.initials: S
authors.lastname: Ferrarello
authors.forename: Damiano
authors.initials: D
authors.lastname: Regazzoli
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Filippo
authors.initials: F
authors.lastname: Figini
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Charbel
authors.initials: C
authors.lastname: Naim
authors.forename: Masanori
authors.initials: M
authors.lastname: Kawaguchi
authors.forename: Argyrios
authors.initials: A
authors.lastname: Gerasimou
authors.forename: Francesco
authors.initials: F
authors.lastname: Giannini
authors.forename: Cosmo
authors.initials: C
authors.lastname: Godino
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D020341:Absorbable Implants; D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011108:Polymers; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D011108:Polymers; D000068338:Everolimus; C518022:umirolimus; D020123:Sirolimus
keywords: biolimus-eluting stent; coronary bifurcation; everolimus-eluting stent